Navigating Medicare Extra Help: What You Need to Know

Medicare can be confusing, especially when paying for prescription drugs. You’re looking for ways to afford your medication without breaking the bank, which is where the Medicare Savings Program called Medicare Extra Help comes in.

You might also see it called “LIS,” which stands for “Low-Income Subsidy.” I’ll walk you through everything you need to know about this vital program so you can get the financial relief you deserve.

What is Medicare Extra Help?

Medicare Extra Help (LIS) is a Medicare assistance program that helps those with limited income and resources pay for their prescription drug costs under Medicare Part D. It reduces what you pay out-of-pocket at the pharmacy for your medications. The Medicare program helps people afford necessary prescription drugs.

Who Qualifies for Medicare Extra Help?

The Social Security Administration (SSA) determines your eligibility for this Medicare Savings Program. Generally, people with limited income and resources qualify for Extra Help. For [medicare_costs value=”medicare-cost-year”], you may qualify if you meet the income and resource limits:

You’re single with an annual income of [medicare_costs value=”partd-lis-income-single”] or less and have savings/assets of [medicare_costs value=”partd-lis-assets-single”] or less.
You’re married, live together, and are both applying for Extra Help with an annual income of [medicare_costs value=”partd-lis-income-married”] or less and have savings/assets of [medicare_costs value=”partd-lis-assets-married”] or less.

You also might automatically qualify if you’re enrolled in any of these:

Medicaid
Medicare and Medicaid (called “dual eligible“)
Supplemental Security Income (SSI)

You can find out more about the resources on Medicare’s website. They have a helpful chart with the latest income and resource limits to determine eligibility.

Benefits of Medicare Extra Help

This program isn’t just about lower drug prices. Medicare Extra Help provides peace of mind by also giving you:

Lower Costs: Depending on your income level, most people enrolled in the program pay $0 for their Medicare drug plan premiums. There’s a good chance you’ll also pay less or nothing at all for your medications.
Special Enrollment Periods: Everyone else with a Medicare drug plan only gets to change plans once a year unless they qualify for a Special Enrollment Period. With Medicare Extra Help, you can switch your Part D drug plan once every quarter – January to March, April to June, July to September, or during Open Enrollment – giving you more flexibility if your medical needs change. Open Enrollment is from October 15th to December 7th each year.
Protection from Late Penalties: Signing up for a plan after you were first eligible normally means a late enrollment penalty that gets added to your monthly Part D premiums. Medicare waives those penalties when you enroll later if you’re in this program.

Starting in 2024, people who make up to 150% of the Federal Poverty Level will automatically qualify for the full Extra Help benefits. This means they will no longer have to apply. This is a game changer for many people struggling to make ends meet, allowing them to afford medicine better.

LIS Categories Explained

There are two main categories of LIS:

1. Full Extra Help (Full Subsidy)

Eligibility: Beneficiaries with incomes at or below 135% of the Federal Poverty Level (FPL) and limited resources.
Benefits:
- No monthly premium (if enrolled in a benchmark plan).
- No deductible.
- Low copayments for prescriptions:
  - $1.55 for generics and $4.15 for brand-name drugs in 2024 (or $0 for people in long-term care).
- No coverage gap (donut hole).
- Reduced or no copayments in the catastrophic coverage phase.

2. Partial Extra Help (Partial Subsidy)

Eligibility: Beneficiaries with incomes between 135% and 150% of the Federal Poverty Level (FPL) and limited resources.
Benefits:
- Sliding scale for monthly premium, based on income.
- A reduced deductible of no more than $104 in 2024.
- 15% coinsurance or the plan’s copayment for prescriptions until reaching catastrophic coverage.
- Reduced copayments in the catastrophic coverage phase.

The various LIS categories provide significant savings for eligible individuals, ensuring access to necessary prescription medications.

How to Apply for Medicare Extra Help

It’s always worth applying for Extra Help, especially since there are several ways to do it. These resources make applying much easier:

NCOA’s BenefitsCheckUp: NCOA is dedicated to helping older adults. They created a site called BenefitsCheckUp specifically for navigating Medicare, benefits, programs, and more.
State Health Insurance Assistance Program (SHIP): SHIPs are local organizations that provide free help to those navigating Medicare. They can walk you through the Medicare Extra Help application.
Social Security Administration: This is where you can apply online or get your questions answered. They also help those who qualify to enroll in a Medicare drug plan.

LINET – Help While You Wait

It can take a while for Medicare to approve your Extra Help application, leaving people scrambling to pay for prescriptions while they wait. The Limited Income Newly Eligible Transition (LINET) program gives people temporary Medicare Part D prescription drug coverage while they wait for their application to process.

Starting in 2024, this becomes a permanent program available to everyone who:

Has Medicare
Qualifies for Medicare Extra Help but hasn’t enrolled in a Medicare drug plan yet

If you are dual-enrolled in Medicare and Medicaid, you will automatically be placed in the LINET program while waiting for Medicare Extra Help approval. If you aren’t dual-enrolled and need to use the program, ask your pharmacist, who can help you.

Conclusion

Medicare Extra Help (LIS) is available for those who need financial assistance to cover medication costs. Don’t navigate Medicare alone. There are solutions designed specifically to help you manage these costs.

Frequently Asked Questions About Medicare Extra Help

You might have questions about Medicare Extra Help, like who qualifies or how to sign up. We’re here to answer them.

What exactly is Medicare Extra Help?

Medicare Extra Help is a program that helps pay for some of your prescription drug costs. It is like getting a discount on your medications, making them more affordable.

Who can get Medicare Extra Help?

This program is for people with limited income and resources. You might qualify with Medicare and meet certain income and asset limits.

How do I apply for Medicare Extra Help?

You can apply online, by phone, or by mail. Visit the Social Security website to apply online. If you prefer to apply over the phone, call Social Security directly.

If I need help with my application, what should I do?

You can get help from your local State Health Insurance Assistance Program (SHIP). They can answer your questions about Medicare Extra Help and help you with the application process.

What happens after I apply?

After you apply, Social Security will review your application and determine if you’re eligible. If you qualify, you’ll get a letter in the mail letting you know. If you don’t, the letter will explain why.